Inadequate management of acute pain negatively impacts numerous aspects of patient health and may increase the risk of developing chronic pain. Studies examining the use of multiple analgesics with different mechanisms of action suggest that multimodal therapies may offer an improved efficacy/tolerability balance over single agent regimens. There exists a significant need for effective, well-tolerated analgesic therapies to limit the negative consequences of undermanaged acute pain. The use of multimodal therapy has demonstrated increasing promise and is supported by current practice guidelines.
Acute pain has been defined as: The physiologic response and experience to noxious stimuli that can become pathologic, is normally sudden in onset, time limited, and motivates behaviours to avoid actual or potential tissue injuries. Acute pain usually lasts for less than seven days but often extends up to 30 days. For some conditions, acute pain episodes may recur periodically. In some patients, acute pain persists to become chronic. Acute pain is ubiquitous following surgery. Pain is the most common reason for emergency department visits and is commonly encountered in primary care, other outpatient and inpatient settings.
The key decisional dilemma in acute pain management involves selection of interventions to provide adequate pain relief, to improve quality of life, improve function and facilitate recovery, while minimising adverse effects and avoiding overprescribing of opioids. However, shortcomings in acute pain care have been documented. In addition to the underlying cause of pain, patient factors that impact acute pain management include age, sex, race/ethnicity, pain severity, comorbidities (including mental health and substance use), genetic factors, pregnancy or breastfeeding status. Timing of presentation and clinical setting can also influence acute pain management. For example, postoperative pain occurs at a specific point in time and is often managed with multimodal strategies in a monitored setting prior to discharge, whereas in outpatient clinic settings, timing of presentation is variable, and assessing treatment response is often not feasible. Additionally, access and care options may vary. Therefore, a treatment that is effective for one acute pain condition and patient in a particular setting may not be effective in others. Opioids, traditionally considered the most potent analgesics, are frequently used for acute pain.
MULTIMODAL PAIN MANAGEMENT
Successful treatment of moderate to severe acute pain often necessitates several analgesics that target different sites of the nociceptive pathway. Fixed-dose combination analgesics facilitate a reduction in dose of individual components, increased compliance and strong-opioid sparing.
Carefully designed oral fixed-dose combination analgesics have potential advantages over monotherapy, which include a reduction in dose of each of the components, theoretically resulting in improved tolerability and safety. The simplified oral regimens of combination analgesics may also be invaluable in promoting compliance.
Acute pain is disabling and common, and while it may be inevitable, treatment with effective analgesics may alleviate the suffering. Aggressive control of acute pain may also reduce the risk of developing chronic or even lifelong pain.
Successful treatment of moderate to severe acute pain often necessitates several analgesics that target different sites of the nociceptive pathway.